Improving hepatitis C treatment for people with HIV

Switching from intravenous to oral therapy would make it easier to access. Alexey Stiop/Shutterstock

A new, combination hepatitis C therapy could shorten treatment times, reduce side effects and improve health outcomes for people who also have HIV, early trial results show.

Worldwide, around one-third of HIV-positive people are co-infected with hepatitis C. These people progress more rapidly into liver failure, one of the long-term complications of hepatitis C.

The researchers set out test treatment alternatives to interferon, the commonly used treatment for hepatitis, to which HIV-positive patients respond poorly.

The researchers found a combination of direct-acting antivirals effectively targeted different aspects of hepatitis C virus replication and produced “sustained virologic responses”, effectively curing patients.

The results of the TURQUOISE-1 study were presented at the AIDS2014 conference in Melbourne.

Led by Mark Sulkowski, medical director of the Johns Hopkins University Viral Hepatitis Centre in Baltimore, researchers treated 63 patients who were co-infected with HIV and hepatitis C with a combination of three direct-acting antiviral drugs, known as 3D, and another drug, ribavirin.

They broke the participants up into 12- and 24-week treatment groups and tested their virologic responses several weeks after treatment ended.

“What we essentially saw was that in the 12-week group, 93.5% achieved sustained response at week 12, post-treatment,” said Dr Sulkowski.

“The 24 week data are still emerging but we’re seeing 97% effectiveness there,” he said.

Dr Sulkowski said the treatment combination had been extensively studied in hepatitis C patients without HIV and had achieved 96% effectiveness after 12 weeks of therapy, so the results were promising.

Improving the efficacy of hepatitis C treatment in people with co-infections was an important priority, Dr Sulkowski said, as the illness was a leading cause of death among people living with HIV/AIDS.

“When you effectively treat the HIV with antiretroviral therapy, and reduce the risk dramatically of death from that pathogen, we’re seeing hepatitis C emerge as a leading cause of liver disease progression to cirrhosis,” he said.

“This is now a leading cause of death in many populations of people with HIV. So as you treat the HIV, hepatitis C becomes one of the major killers.”

The combination therapy is not yet approved or available, and may be several years away, Dr Sulkowski noted.

“I do think that over the next two or three years we’re going to see multiple regimens emerge, all very effective at curing hepatitis C,” he said.

“That should provide some ability for payers to select regimens based not only on how well they work – their safety, tolerability and efficacy – but also based on price. And perhaps that will lead to an overall cost saving for patients.”

Suman Majumdar, infectious diseases specialist at the Burnet Institute, said the most important finding was these treatments were available without injection, making them more accessible.

“Current treatment for hepatitis C involves an injection given every week, which is still what we use in Australia and that also has significant side effects,” said Dr Majumdar, who was not involved in the study.

“Access to medicines is an important issue and we should apply the lessons we’ve learnt from HIV to the other diseases,” he said.

Tracy Swan, Hepatitis/HIV Director of the Treatment Action Group USA, said pricing was already a significant barrier to accessing the emerging class of direct-acting antiviral drugs, with drug companies charging “extortionate” amounts of US$1,000 a day.

“You can generically produce, with profit sustainability, a treatment course for people with hepatitis C, regardless of the HIV status, their liver disease status, etc., for less than $300 a year,” she said.

“So it’s time to look at patent barriers, IP and what the real pricing benchmark should be based on,” she said.

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